Opinion columnist and blogger at The Atlanta Journal-Constitution.

Opinion: Death makes health-care debate unique

If you’ve watched much TV, you’ve probably seen the ads from pharmaceutical giant Bristol-Myers Squibb, which is spending more than $100 million annually on the campaign.

“For adults with an advanced lung cancer called squamous non-small-cell,” the announcer says, “… it’s not every day that something this big comes along: A chance to live longer, with Opdivo.” That message — “A Chance To Live Longer” — is driven home in large white letters throughout the ad, which features grateful-looking patients watching a baseball game, playing with a grandchild or otherwise spending time with loved ones.

The ad doesn’t present Opdivo as a cure, because it can’t. In lung cancer cases, it is approved for use only when other treatment regimens have failed. The average patient on Opdivo survives an additional 90 days compared to a patient on standard chemotherapy, and the side effects can be so severe that patients cease treatment altogether.

Now, the human survival instinct is a powerful thing, and for someone with Stage IV lung cancer, those 90 additional days can have a lot of appeal. But if placed into context, and if we have the courage to address it honestly, the Opdivo case also opens the door to a broader, deeper discussion of the health care industry, morality, economics, politics and hard truths about human existence.

For example, the Opdivo ads focus on treatment for lung-cancer patients, although the drug is approved for late-stage melanoma and kidney cancer as well. Nationwide, less than 200,000 cases of non-small-cell lung cancer occur each year. So if Bristol-Myers Squibb is advertising its small-market drug in the same expensive, mass-market fashion that Budweiser advertises beer, you might suspect that its per-unit profit must be pretty high.

You would be correct. In the third quarter alone, Opdivo generated $920 million in revenue for Bristol-Myers Squib. The company generates that revenue by charging patients roughly $140,000 for the initial treatment, with an additional $14,000 for each subsequent month.

I’m a healthy person, and I have no loved one with lung cancer. But with three important caveats, I can sit here and tell you that if I were diagnosed with late-stage lung cancer, I don’t think I would pursue Opdivo treatment. Prolonging the inevitable with a questionable quality of life doesn’t interest me much.

But the caveats? First, that’s a personal decision, not a decision that I impose on others; second, if the patient were a loved one, I might think differently about the value of those extra 90 days; finally, and candidly, until I’m actually faced with that grim diagnosis, my armchair theorizing about what I might do can’t really be trusted.

From there, the questions grow broader and more complicated. Does a lifespan increase of 90 days justify a $200,000 cost when that cost is shifted either to taxpayers or other insurance customers? How many lives could be saved outright if the billions spent on Opdivo were spent instead on, say, smoking cessation or opiate addiction treatment?

In Britain, officials have refused to approve Opdivo for ordinary use on the grounds that it is too expensive and have urged Bristol-Myers to lower its cost. Yes, they are explicitly rationing health care on grounds of cost, but lest we Americans get high and mighty, the current debate in Washington over the fate of Obamacare, Medicare and Medicaid is, at root, also about rationing health care on the grounds of cost.

Reader Comments 1

I know a woman who is covered under Obamacare by her husband, but when she goes to the hospital (diabetes, COPD) she does not admit she is covered because then she would have to eventually pay. She says, 'Why pay when it can be gotten for free?" That is the kind of thinking the new Obamacare must fight against, or at least take into account.

The fundamental error that politicizes these issues and raises such questions as some people's choices being imposed on others and shifting costs to taxpayers is entangling government and healthcare. An important part of this process was indirect, with World War II wage and price controls forcing employers to use non-wage means to compete for employees, giving us a big push in the direction of tying health insurance to employment, and thus creating problems when people changed jobs; this is why pre-existing conditions have become such an issue. If we separate government and health care, health care will be free of politics and health care issues will be less thorny.

@RandroidWillBoy@StraightNoChaser I understand perfectly, they want to make up for tax breaks for the rich by taxing the middle income on our employer based pre taxed insurance. You need to read the article once before casting aspersions.

@td1234@StraightNoChaser More than likely you have not read the article and have no clue what it is saying so speak for yourself, they want to tax the working class yet still give a tax break to companies. We pay just as much for our insurance as they do to help cover us. Stop making excuses for abuse of us middle income workers. One thing that is for sure about tax breaks for the rich someone has to pay for them and it's always the middle income that covers those tax breaks in one form or the other.

He seems to be speaking in different directions..maybe to make a point, maybe to be controversial....talks about charity then qualifies it as not justice...true but it seems much of the context is missing in this interview...the comments are quite a read.

My close high-school friend went on to a senior leadership position with one of the world's largest commodity traders.

At any rate, I wonder what distraction the Trump Ministry of Propog...er...Communications will come up with to enable Don to weasel out of his much anticipated forthcoming presser. Should be a good one if he actually shows up.

@Bruno2@_GodlessHeathen_ She was long and lanky and used to beat up kids to take their money. Then she became that one-trick pony (arm bar) until she got her ash kicked by real fighters. You're right, Bruno, she "fought" women who were just a few months removed from being a teacher, a yoga instructor, etc. Blechh...

@_GodlessHeathen_@elgrunir@Bruno2 She's had the courage to fail and to bounce back, even against heavy criticism of her acting. She's had the courage to branch out and do all sorts of roles in theater, television, and on screen.

@RandroidWillBoy@elgrunir@Bruno2@_GodlessHeathen_Easy. She took the money and ran. Millions saw it. She did nothing to improve herself since the last fight. Yeah, when someone doesn't care, gives zero effort, and stiffs the audience, I'm gonna judge. Oooh, she's goona be an announcer? How can she possibly comment on someone's courage or lack thereof?

@RandroidWillBoy@elgrunir@Bruno2@_GodlessHeathen_ I haven't stepped in a ring with millions watching, but fewer. I have, however, also stepped in front of a gun that was fired (shot went over my head) and saved a life of a stabbing victim. Oh, and if you want proof, you are welcome to come out here or have any agent out here to verify.

She speaks about being one of the most vilified groups with the press and foreigners then proceeds to suggest that by calling out actors in the audience who were foreigners or disadvantaged originally. The thing she doesn't mention is that they all came here legally (it seems) whereas the beef of the dopes on the right have to do with illegals. Another Hollywood (great regardless of content) performance. Perhaps if they would have spent time in Michigan, PA, and Florida instead of in their million dollar homes sending out twitter crap we wouldn't be dealing with Trump.

I think her point is that she feels vilified by Trump and his crew same as the media and whatever is meant by "foreigners".

She truly seemed like her feelings were hurt....Hollywood is a bubble that has no connection (except selling product) to those who voted for Trump out of sheer frustration.....all who have no empathy for those people are missing the big picture here.